血清胆红素水平与IgA肾病临床病理相关性研究

发布时间：2018-11-13 12:20

【摘要】：目的:探讨血清胆红素水平与IgA肾病临床及病理的关系,为指导IgA肾病患者的治疗提供理论依据。方法:回顾性横断面研究。纳入2008年8月至2015年12月在宁夏医科大学总医院肾脏内科明确诊断为IgA肾病的患者。收集患者的一般资料、实验室检查及病理资料。分析IgA肾病患者血清胆红素水平与实验室指标及病理结果的关系。结果:本研究共纳入IgA肾病患者612例,其中男性患者326例(53.3%),女性患者286例(46.7%)。(1)血清胆红素水平按四分位数间距分组,随着血清胆红素水平逐渐升高,血清总蛋白、白蛋白、血红蛋白水平逐渐升高,血糖、24小时尿蛋白定量逐渐减低,肾小球系膜细胞增生、肾小管萎缩/间质纤维化的程度逐渐减轻(P0.05);(2)将24小时尿蛋白定量以1g为界分组,24小时尿蛋白定量≥1g较1g组患者的舒张压、收缩压、平均动脉压、血清肌酐、甘油三酯水平高,总蛋白、白蛋白、胆红素、eGFR低,病理损伤程度重(P0.05);(3)将eGFR以45 ml/min/1.73m2为界分组,eGFR≥45ml/min/1.73m2组较45 ml/min/1.73m2组患者年龄小,舒张压、收缩压、平均动脉压、血清肌酐、尿酸、24小时尿蛋白定量、血红蛋白水平低,高血压的发生率低,胆红素、总蛋白、白蛋白水平高,病理损伤程度轻(P0.05);(4)按临床表现是否为肾病综合征分组,肾病综合征组的患者舒张压、收缩压、平均动脉压、血清肌酐、总胆固醇较非肾病综合征组高,胆红素、血红蛋白、eGFR水平低,系膜细胞增生、肾小管萎缩/间质纤维化程度重(P0.05);(5)系膜细胞增生程度分组,M1组的收缩压、平均动脉压、血清肌酐、血糖、尿蛋白定量、血尿发生率较M0组高,总蛋白、胆红素、血红蛋白、eGFR较M0组低(P0.05);(6)以肾小管萎缩/间质纤维化程度分组,随着病理损伤程度加重,舒张压、收缩压、平均动脉压、血清肌酐、尿酸、尿蛋白定量、高血压的发生率逐渐增加,总蛋白、白蛋白、血红蛋白、eGFR逐渐降低,T0组的胆红素水平较T1和T2组高(P0.05);(7)相关危险因素Logistic回归分析显示:IgA肾病患者舒张压、收缩压、血清肌酐、血糖、尿蛋白定量升高为系膜细胞增生的非保护性因素,胆红素、血红蛋白、eGFR升高为系膜细胞增生的保护性因素(P0.05);舒张压、收缩压、平均动脉压、血清肌酐、尿酸、尿蛋白定量升高为肾小管萎缩/间质纤维化的非保护性因素,总蛋白、白蛋白、胆红素、血红蛋白、eGFR升高为肾小管萎缩/间质纤维化的保护性因素。结论:血清胆红素水平可能在IgA肾病的发生发展中起一定作用,高血清胆红素水平的IgA肾病患者其临床病理可能更轻。
[Abstract]:Objective: to investigate the relationship between serum bilirubin level and clinical and pathological changes of IgA nephropathy, and to provide theoretical basis for guiding the treatment of IgA nephropathy. Methods: retrospective cross-sectional study. The patients with IgA nephropathy were included in the Department of Renal Medicine, General Hospital of Ningxia Medical University from August 2008 to December 2015. Collect general data, laboratory examination and pathological data of patients. To analyze the relationship between serum bilirubin level and laboratory indexes and pathological results in patients with IgA nephropathy. Results: a total of 612 patients with IgA nephropathy were included in this study, including 326 male patients (53.3%) and 286 female patients (46.7%). (1) whose serum bilirubin levels were grouped according to quartile spacing. With the increase of serum bilirubin level, serum total protein, albumin, hemoglobin level gradually increased, blood sugar, 24 hours urine protein quantity decreased gradually, glomerular Mesangial cells proliferated. The degree of tubular atrophy / interstitial fibrosis gradually decreased (P0.05). (2) the 24 hour urinary protein quantification was divided into 1 g and 1 g respectively. The diastolic blood pressure, systolic blood pressure, mean arterial pressure, serum creatinine, triglyceride level, total protein, albumin, bilirubin and eGFR were lower in 24 hours urinary protein 鈮，

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